Intellectual Disabilities/Mental Intellectual Disabilities/Mental RetardationRetardation

In-service Presented by:In-service Presented by:

Lyndsey Carlson, Nicole Fagg, Angela Lyndsey Carlson, Nicole Fagg, Angela Reich, Kendra Heyer, and Monica Reich, Kendra Heyer, and Monica

HernandezHernandez

Basic ConceptsBasic Concepts Mental retardation (MR) is a disability Mental retardation (MR) is a disability

characterized by significant limitations characterized by significant limitations both in intellectual functioning and in both in intellectual functioning and in adaptive behavior as expressed in adaptive behavior as expressed in conceptual, social, and practical adaptive conceptual, social, and practical adaptive skills. This disability originates before age skills. This disability originates before age 18. It is also defined as a level of 18. It is also defined as a level of functioning significantly below what is functioning significantly below what is considered to be “average.” “The U.S. considered to be “average.” “The U.S. Department of Education (2006) reported Department of Education (2006) reported that the percentage of children between that the percentage of children between the ages of six and seventeen served the ages of six and seventeen served under the category of MR was 1.04under the category of MR was 1.04 percent” (Smith 212).percent” (Smith 212).

Lyndsey

Basic Concepts Cont.Basic Concepts Cont.

In 2006, the U.S. Department of Education In 2006, the U.S. Department of Education reported the percentage of children between reported the percentage of children between the ages 6 and 17 served under the category the ages 6 and 17 served under the category of MR was 1.04%. The range was significant of MR was 1.04%. The range was significant across individual states, from 3.1% (West across individual states, from 3.1% (West Virginia) to 0.37% (New Jersey). Virginia) to 0.37% (New Jersey).

The prevalence of MR in individuals of school-The prevalence of MR in individuals of school-age tends to be higher than in adults. This is age tends to be higher than in adults. This is because of the challenges of formal education because of the challenges of formal education for school-age individuals, as well as, the for school-age individuals, as well as, the relative lack of identification in adulthood. relative lack of identification in adulthood.

The estimated prevalence of MR in the general The estimated prevalence of MR in the general population is 0.78% (Smith p.21).population is 0.78% (Smith p.21).

TerminologyTerminology Intellectual disabilities (ID)- Intellectual disabilities (ID)- conveys a broad-based conveys a broad-based

concept that places under it deficits in varied cognitive concept that places under it deficits in varied cognitive and adaptive ability areas. In turn, this term has and adaptive ability areas. In turn, this term has received little acceptance internationally so the received little acceptance internationally so the American Association on Mental Retardation has American Association on Mental Retardation has changed its name to reflect this newer and broader changed its name to reflect this newer and broader term…term…

Developmental disabilities- Developmental disabilities- The term has become The term has become more popular mainly for reference to programs for more popular mainly for reference to programs for adults and professional organizations, although it is used adults and professional organizations, although it is used far less frequently in the schools. The problem is the far less frequently in the schools. The problem is the mere rendering of the term, Developmental disabilities, mere rendering of the term, Developmental disabilities, which would exclude 40% of those people who might which would exclude 40% of those people who might otherwise have been identified as mildly mentally otherwise have been identified as mildly mentally retarded. retarded.

Mental Retardation (MR)- Mental Retardation (MR)- Professionals and parents Professionals and parents have been hesitant to use the term MR to refer to young have been hesitant to use the term MR to refer to young children for many years. The term is rarely used during children for many years. The term is rarely used during the preschool years and in many states the term is the preschool years and in many states the term is deferred until children reach the age of nine. deferred until children reach the age of nine.

TerminologyTerminology

Developmental Delay (DD)- Developmental Delay (DD)- is recognized is recognized by the federal government as the preferred by the federal government as the preferred term for younger children through the age of term for younger children through the age of 8. 8.

Mild Retardation-Mild Retardation- A newer, broader term for A newer, broader term for developmental disabilities. However, the term developmental disabilities. However, the term presents as an oxymoron in that it may convey presents as an oxymoron in that it may convey mild as insignificant. For instance, “a mild mild as insignificant. For instance, “a mild cold”. Many people avoid term Mild cold”. Many people avoid term Mild Retardation in fear of judging or labeling.Retardation in fear of judging or labeling.

High-incidence disabilityHigh-incidence disability- is the encouraged - is the encouraged term to use, rather than, mild retardation. term to use, rather than, mild retardation. However, no term is without criticism.However, no term is without criticism.

History of Mental History of Mental RetardationRetardation

Many positive changes have Many positive changes have occurred in the treatment of occurred in the treatment of individuals with mental retardation individuals with mental retardation in the late twentieth century.in the late twentieth century.– Movement away from restricted, Movement away from restricted,

sometimes abusive settings.sometimes abusive settings.– Positive shifts in public attitudesPositive shifts in public attitudes– Improved services and supportsImproved services and supports

Court CasesCourt Cases Penry v. Lynaugh (1989)Penry v. Lynaugh (1989)

– Said that the death penalty for people with Said that the death penalty for people with MR was not “cruel and unusual punishment”. MR was not “cruel and unusual punishment”.

– Used a competency evaluation during trial to Used a competency evaluation during trial to diagnose Penry with MR.diagnose Penry with MR.

– Was overturned by Atkins v Virginia rulingWas overturned by Atkins v Virginia ruling Atkins v. Virginia (2002)Atkins v. Virginia (2002)

– Said that the death penalty was “cruel and Said that the death penalty was “cruel and unusual punishment” unusual punishment”

– Saved many people with MR from the death Saved many people with MR from the death penalty.penalty.

Monica

Basis for DiagnosisBasis for Diagnosis

AAIDD’s definitions are generally considered as AAIDD’s definitions are generally considered as the basis for diagnosis.the basis for diagnosis.

Three concepts are central to the AAIDD’s recent Three concepts are central to the AAIDD’s recent definitions:definitions:– Intellectual FunctioningIntellectual Functioning

Cognitive abilitiesCognitive abilities Operationally, performance of an IQ testOperationally, performance of an IQ test IQ alone is not a sufficient for a diagnosisIQ alone is not a sufficient for a diagnosis

– Adaptive Behavior or SkillsAdaptive Behavior or Skills ““the standards of maturation, learning, personal the standards of maturation, learning, personal

independence, and/or social responsibility that are independence, and/or social responsibility that are expected for his or her age level and cultural group” expected for his or her age level and cultural group” (Grossman, 1983, p.11)(Grossman, 1983, p.11)

– Developmental PeriodDevelopmental Period Time period between conception and 18 years of ageTime period between conception and 18 years of age Below-average intellectual functioning and disabilities in Below-average intellectual functioning and disabilities in

adaptive behavior must appear during this periodadaptive behavior must appear during this period

Lyndsey

Contemporary DefinitionContemporary Definition

Mental retardation is a disability Mental retardation is a disability characterized by significant characterized by significant limitations both in intellectual limitations both in intellectual functioning and in adaptive functioning and in adaptive behavior as expressed in behavior as expressed in conceptual, social, and practical conceptual, social, and practical skills. skills. (Luckasson et al., 2002)(Luckasson et al., 2002)

This disability originates before This disability originates before age 18.age 18.

ClassificationsClassificationsDeficit SystemDeficit System

MildMild ModerateModerate Severe Severe Profound retardationProfound retardation Summative judgments Summative judgments

based on intelligence and based on intelligence and adaptive behavior adaptive behavior assessmentsassessments

Alternative SystemsAlternative Systems

Educable and trainable Educable and trainable Educable Mentally Retarded (EMR) Educable Mentally Retarded (EMR) Trainable Mentally Retarded (TMR)Trainable Mentally Retarded (TMR) Mild or Severe with Mild or Severe with NONO IQ scores IQ scores AAIDD classification system of AAIDD classification system of

Luckasson and colleagues Luckasson and colleagues (1992,2002) - classification based (1992,2002) - classification based on levels of support neededon levels of support needed– ““Supports are resources and Supports are resources and

strategies that aim to promote strategies that aim to promote the development, education, the development, education, interests, and personal well-interests, and personal well-being of a person and that being of a person and that enhance individual functioning”enhance individual functioning”

Kendra

AAIDDAAIDD(American Association on (American Association on Intellectual and Developmental Intellectual and Developmental Disabilities)Disabilities) 4 General Levels of Support 4 General Levels of Support

Intermittent – support on an “as needed basis” Intermittent – support on an “as needed basis” by episodic or short-term nature; high or low by episodic or short-term nature; high or low intensity intensity

Limited – Consistent support over time; time-Limited – Consistent support over time; time-limitedlimited

Extensive – Support that includes regular Extensive – Support that includes regular involvement in at least some environments involvement in at least some environments and not time-limitedand not time-limited

Pervasive – Support that is constant, high Pervasive – Support that is constant, high intensity, life sustaining nature; involves more intensity, life sustaining nature; involves more staffstaff

PrevalencePrevalence

Approximately 1% of school Approximately 1% of school

population is identified with population is identified with

Mental RetardationMental Retardation

50% had mild retardation 50% had mild retardation

56% were male56% were male

Race and EthnicityRace and Ethnicity

– 1.1% - Native 1.1% - Native

Americans/AlaskansAmericans/Alaskans

– 1.8 % - Asian/Pacific 1.8 % - Asian/Pacific

IslandersIslanders

– 34.5% - African Americans34.5% - African Americans

– 12.5 % - Hispanic12.5 % - Hispanic

– 50.6% - European 50.6% - European

Americans Americans

CausesCauses

Down Syndrome – Trisomy 21 (3 Down Syndrome – Trisomy 21 (3 pairs rather than 2)pairs rather than 2)

Environmental or Psychological Environmental or Psychological Disadvantages Disadvantages

Fetal Alcohol Syndrome – Caused by Fetal Alcohol Syndrome – Caused by drinking during the pregnancydrinking during the pregnancy

Fragile X Syndrome – Genetic Fragile X Syndrome – Genetic disorder related to gene or X disorder related to gene or X chromosome chromosome

Causes Cont.Causes Cont.

Hydrocephalus – Disruption in Hydrocephalus – Disruption in appropriate flow of cerebrospinal fluid appropriate flow of cerebrospinal fluid on the brainon the brain

Phenylketonuria – Autosomal Phenylketonuria – Autosomal recessive genetic disorderrecessive genetic disorder

Prader-Willi Syndrome – Chromosomal Prader-Willi Syndrome – Chromosomal error of the autosomal typeerror of the autosomal type

Tay-Sachs – Autosomal recessive Tay-Sachs – Autosomal recessive genetic disordergenetic disorder

CharacteristicsCharacteristics

Problems in attention are commonProblems in attention are common 10% of students with ADHD have a 10% of students with ADHD have a

primary diagnosis of MRprimary diagnosis of MR student’s achievement is student’s achievement is

proportional to the expectations proportional to the expectations set by the teachers set by the teachers

Monica

Problem Areas with MRProblem Areas with MR

attention Spanattention Span focusfocus strategy productionstrategy production short term Memoryshort term Memory applying knowledge applying knowledge

to new tasksto new tasks external locus of external locus of

control control

outer directedness, outer directedness, symbolic though, symbolic though, delayed acquisition delayed acquisition

of vocabulary, of vocabulary, social adjustment, social adjustment, self-esteemself-esteem peer acceptance peer acceptance

Identification, Assessment and Identification, Assessment and PlacementPlacement

Intellectual functioning and adaptive Intellectual functioning and adaptive behavior are two key prongs for the behavior are two key prongs for the eligibility and assessment processeligibility and assessment process

1950’s-1970’s students with MR were 1950’s-1970’s students with MR were taught in a self-contained classroomtaught in a self-contained classroom

Inclusion was increased, however Inclusion was increased, however students with MR are less likely to be students with MR are less likely to be included in the classroom for most or included in the classroom for most or all of the school dayall of the school day

Transition ConsiderationsTransition Considerations

Fewer than half of students with Fewer than half of students with MR complete the designated MR complete the designated academic curriculumacademic curriculum– 25% graduated with a diploma25% graduated with a diploma– 17.6 received a certificate17.6 received a certificate

““Floundering” is the transition Floundering” is the transition period after leaving high schoolperiod after leaving high school

Nicole

Challenges of AdulthoodChallenges of Adulthood

Employment/EducationEmployment/Education– General job skills General job skills – General educationGeneral education– Employment settingsEmployment settings

Home and FamilyHome and Family– Home managementHome management– Financial managementFinancial management

Leisure PursuitsLeisure Pursuits– Indoor/outdoor activitiesIndoor/outdoor activities

Essential Features for Essential Features for TransitionTransition

Transition efforts must start earlyTransition efforts must start early Decisions must balance what is ideal and Decisions must balance what is ideal and

possiblepossible Active and meaningful student Active and meaningful student

participation and family involvementparticipation and family involvement Supports are beneficialSupports are beneficial Community-based instructional Community-based instructional

experiencesexperiences Transition planning is needed by all Transition planning is needed by all

students students

Strategies for Curriculum and Strategies for Curriculum and InstructionInstruction

Four Primary Goals Four Primary Goals – Productive EmploymentProductive Employment

Build students career awareness and help Build students career awareness and help them see how academic content relates them see how academic content relates to applied situationsto applied situations

– Independence and Self-SufficiencyIndependence and Self-Sufficiency Young adults need to become responsible Young adults need to become responsible

for themselves. for themselves. – One essential element of empowerment is self One essential element of empowerment is self

determination!determination!

Strategies for Curriculum and Strategies for Curriculum and InstructionInstruction

Four Primary Goals Cont.Four Primary Goals Cont.– Life Skills CompetenceLife Skills Competence

Focus on the importance of competence Focus on the importance of competence in everyday activities.in everyday activities.

– Use of community resources, home and family Use of community resources, home and family activities, social and interpersonal skills, activities, social and interpersonal skills, health and safety skills, use of leisure time, health and safety skills, use of leisure time, and participation the community as a citizen.and participation the community as a citizen.

– Successful School and Community Successful School and Community InvolvementInvolvement

Requires that students experience Requires that students experience inclusive environments.inclusive environments.

Classroom AdaptationsClassroom Adaptations

InclusionInclusion is the program of choice is the program of choice for more students with MRfor more students with MR

AdaptationsAdaptations for MR students: for MR students: instructional delivery systems and instructional delivery systems and response modesresponse modes– EX: Testing adaptations for extended EX: Testing adaptations for extended

timetime Specialized curriculumSpecialized curriculum is less is less

common in students with MRcommon in students with MRAngela

Classroom AdaptationsClassroom Adaptations

Focus on teaching and learning Focus on teaching and learning adaptations that:adaptations that:– Ensure attentionEnsure attention– Teach ways to learn content while Teach ways to learn content while

teaching content itselfteaching content itself– Focus on meaningful content to the Focus on meaningful content to the

students that promote students that promote learning/applicationlearning/application

– Provide training that includes multiple Provide training that includes multiple learning and environmental contentslearning and environmental contents

– Opportunities for active involvementOpportunities for active involvement

Classroom AdaptationsClassroom Adaptations Teachers need to focus on the learning Teachers need to focus on the learning

process (not content alone.)process (not content alone.)– Strategy Training (acquire, retain and master Strategy Training (acquire, retain and master

relevant curriculum skills)relevant curriculum skills) Curricular adaptationsCurricular adaptations: focus on relevant and : focus on relevant and

meaningful content that students can master meaningful content that students can master and apply to their current and future livesand apply to their current and future lives– Learning, working, and residingLearning, working, and residing

Assistive TechnologyAssistive Technology: improve learning : improve learning environments for each of the 4 stages of environments for each of the 4 stages of respective learning:respective learning:– The acquisition of new skillsThe acquisition of new skills– Development of fluency and proficiencyDevelopment of fluency and proficiency– Maintenance of skills overtimeMaintenance of skills overtime– Generalization of skills (learned to other settings Generalization of skills (learned to other settings

beyond school)beyond school)

Promoting Inclusive Promoting Inclusive PracticesPractices

Create a sense of community in the Create a sense of community in the classroom as well as the schoolclassroom as well as the school

For students to succeed, they should be For students to succeed, they should be welcomed, encourages, and involvedwelcomed, encourages, and involved

Key friendships create a “belonging Key friendships create a “belonging place” in the general education place” in the general education classroomclassroom

Teachers can promote an environment Teachers can promote an environment in which the benefits of friendships can in which the benefits of friendships can be realized.be realized.

Final ThoughtsFinal Thoughts

Students with mental retardation Students with mental retardation require a comprehensive, broad-require a comprehensive, broad-based curriculum.based curriculum.

Most effective programs will:Most effective programs will:– Provide appropriate academic Provide appropriate academic

instructioninstruction– Address social skills, life skills, and Address social skills, life skills, and

transition skillstransition skills– Incorporate a “life” inclusion philosophyIncorporate a “life” inclusion philosophy

Journal ArticlesJournal Articles 1.  1.  Mental Health Disorders among Mental Health Disorders among

Individuals with Mental Retardation: Individuals with Mental Retardation: Challenges to Accurate Prevalence Challenges to Accurate Prevalence EstimatesEstimates

2.  2.  Public Conceptions of Mental Public Conceptions of Mental Illness in 1950 and 1996: What Is Illness in 1950 and 1996: What Is Mental Illness and Is It to be Feared?Mental Illness and Is It to be Feared?

3. 3. Spinal Cord Compromise: An Spinal Cord Compromise: An Important but Under diagnosed Important but Under diagnosed Condition in People with Mental Condition in People with Mental RetardationRetardation

ResourcesResources Cornell University Law School. Retrieved March 23, 2009, from Cornell University Law School. Retrieved March 23, 2009, from

Supreme Court Collection Web site: Supreme Court Collection Web site: www.law.cornell.edu/supct/html/00-8452.ZS.html www.law.cornell.edu/supct/html/00-8452.ZS.html

the International Justice Project. Retrieved March 23, 2009, from the International Justice Project. Retrieved March 23, 2009, from Current Court Cases- Mental Retardation Web site: Current Court Cases- Mental Retardation Web site: www.internationaljusticeproject.org/retardationCurCases.cfm www.internationaljusticeproject.org/retardationCurCases.cfm

Smith, Tom Smith, Tom Teaching Students with Special Needs in Inclusive Teaching Students with Special Needs in Inclusive SettingsSettings. .

Journal Article 1: Kerker, B (2004).Mental Health Disorders among Journal Article 1: Kerker, B (2004).Mental Health Disorders among Individuals with Mental Retardation: Challenges to Accurate Individuals with Mental Retardation: Challenges to Accurate Prevalence Estimates . Prevalence Estimates . Public Health Reports Public Health Reports . . 119119, 409-417. , 409-417.

Journal Article 2: Phelan, Jo C. (2000).Public Conceptions of Mental Journal Article 2: Phelan, Jo C. (2000).Public Conceptions of Mental Illness in 1950 and 1996: What is Mental Illness an Is It to be Illness in 1950 and 1996: What is Mental Illness an Is It to be Feared?. Feared?. Journel of Health and Social BehaviorJournel of Health and Social Behavior. . 4141, 188-207. , 188-207.

Journal Article 3: Curtis, Rod (2004).Spinal Cord Compromise: An Journal Article 3: Curtis, Rod (2004).Spinal Cord Compromise: An Important but Underdiagnosed Condition in People with Mental Important but Underdiagnosed Condition in People with Mental Retardation. Retardation. Public Health ReportsPublic Health Reports. . 119119, 396-400. , 396-400.